Individual provider Active NPI

Melissa Lenderman, PA-C

  • Physician Assistant
  • Pittsfield, IL
National Provider Identifier
1295761724
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006701 Issued in IL
Practice address
320 N Madison St
Pittsfield, IL 62363
Phone
(217) 285-9601
NPI assigned
Jun 25, 2006
Last updated
Aug 16, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA136 TN
Physician Assistant 363A00000X 085006701 IL Primary

Addresses

Primary practice location

320 N Madison St
Pittsfield, IL 62363

Mailing address

1025 Maine St
Quincy, IL 62301-4096
Phone (217) 222-6550

Other identifiers 2

IdentifierTypeStateIssuer
3668023MedicaidTN
CA7018OtherTNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180905000783 IL Practitioner - Physician Assistant 5991737595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

320 N Madison St
Pittsfield, IL 62363-1412
Phone (217) 285-9601

868 Mortimer St
Barry, IL 62312-1249
Phone (217) 335-2343

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085006701ILMDPhysician Assistant
PA136TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Aug 20, 2018 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Aug 20, 2018 Accepting new patients
Three Rivers Medical PastSince Apr 1, 2020 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Past Accepting new patients
Abercrombie Radiological Consultants Inc Past Accepting new patients

Locations

320 N Madison St
Pittsfield, IL 62363
Phone (217) 285-9601

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534377600000",
    "number": "1295761724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014096",
            "telephone_number": "217-222-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N MADISON ST",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "62363",
            "telephone_number": "217-285-9601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LENDERMAN",
        "first_name": "MELISSA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2018-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA136",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3668023",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA7018",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsfield, IL

Sources for this page

Verify at the official NPI Registry.